Effects of iron supplementation versus dietary iron on the nutritional iron status: Systematic review with meta-analysis of randomized controlled trials

ABSTRACT

This meta-analysis compared the effects of dietary intervention versus iron supplementation on biochemical parameters related to the iron nutritional status in humans. The PubMed, CENTRAL, LILACS, SCIELO, OPENGREY.EU and ClinicalTrials.gov databases were searched for randomized clinical trials that assigned individuals to a dietary intervention or to an iron supplementation regimen, for 12 weeks or more. The primary outcome was the hemoglobin concentration, and secondary outcomes were ferritin, RDW, mean corpuscular volume, soluble transferrin receptor, total iron binding capacity, serum iron, and transferrin saturation. From the 6095 records identified, twelve studies were included, six with children, five with adolescents/adults, and one with pregnant women. In the subgroup of studies that included anemic/iron deficient children, supplementation significantly increased the hemoglobin concentration (weighted mean difference (WMD): 3.19 g/L [95% CI: 1.31, 5.07]) and induced a significantly greater reduction of the soluble transferrin receptor (WMD: −0.46 mg/L [95% CI: −0.70, −0, 21]), when compared to dietary intervention. It also induced a greater reduction of the total binding capacity of iron in adolescents/adults (WMD: −6.96 μmol/L [95% CI: −12.70, −1.21]). Supplementation showed a better effect on hemoglobin recovery in anemic/iron deficient children, while no differences were observed between supplementation and dietary intervention in treating adolescents/adults.

KEYWORDS:

• Anemia
• hemoglobin
• diet
• ferrous sulfate

Conflicts of interest

The authors have no conflicts of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in this manuscript.

Authors' contribution

Luiz Gonzaga Ribeiro Silva Neto: preparation of the project, first reviewer, data collection and analysis, drafting of the manuscript. João Eudes dos Santos Neto: second reviewer, collection and analysis of the data, preparation of the manuscript. Nassib Bezerra Bueno: elaboration of the project, analysis of the data and preparation of the manuscript. Suzana Lima de Oliveira: elaboration of the project, data analysis and preparation of the manuscript. Terezinha da Rocha Ataide: elaboration of the project, analysis of the data and preparation of the manuscript.